Articoli Scientifici

This article aims to offer an overview of our knowledge about separation/disloyalty guilt, a maladaptive kind of interpersonal guilt that derives from pathogenic beliefs that associate the healthy and adaptive goals of being separate, different, and independent from important others with the danger of deeply hurting them. These pathogenic beliefs stem from early relational traumas and adverse experiences, such as having had relatives who showed their children that they were visibly hurt by the attempts at exploration and differentiation from their children. Separation/disloyalty guilt has been shown to correlate with eating disorders, panic disorders, obsessive and phobic disorders, illness anxiety disorder, and with transdiagnostic features such as difficulties in mentalization, emotion regulation, and intolerance to frustration. We describe how patients with separation/disloyalty guilt can look for disconfirmations of these pathogenic beliefs during their psychotherapies and how clinicians can help them have the corrective emotional experiences they need.

This paper aims to provide an overview of self-hate, a concept developed by control-mastery theory (CMT) to describe a set of pathogenic beliefs that share the common core of a deeply negative self-representation and self-evaluation, and that are often at the basis of severe personality pathology. Pathogenic beliefs that support self-hate are developed to adapt to early traumatic relationships that made the person feel unrecognized and unloved for who they are. These pathogenic beliefs make the person feel bad, inadequate, unworthy, and undeserving; in addition, empirical research has shown that they are often associated with relevant transdiagnostic psychopathological factors such as difficulties in mentalization, emotional dysregulation, low self-esteem, deep feelings of shame and guilt, depression, interpersonal problems, and a low level of personality functioning. During psychotherapy, patients with issues related to self-hate can be very challenging, and it can be difficult for therapists to develop a strong alliance with them. We will overview the principal manifestations of self-hate, the features of the traumas at its basis, the empirical research data collected on its psychopathological correlates, and their implications for treatment, stressing the importance of therapists’ attitudes and the centrality of corrective emotional experiences.

Introduction This study investigated the relationship between illness anxiety and interpersonal guilt as conceived in control-mastery theory. Additionally, we explored how illness anxiety symptoms relate to general anxiety, depression, alexithymia, autonomic nervous system reactivity, personality functioning impairment, sociodemographic factors, and childhood experiences. Methods A sample of 201 participants completed measures of illness anxiety (Health Anxiety Questionnaire), interpersonal guilt (Interpersonal Guilt Rating Scale-20s), anxiety (State-Trait Anxiety Inventory), depression (Beck Depression Inventory-II), alexithymia (Toronto Alexithymia Scale-20), personality dysfunction (Level of Personality Functioning-Brief Form 2.0), and autonomic nervous reactivity (Body Perception Questionnaire-22). Sociodemographic and childhood traumas and adverse experiences data were collected via an ad hoc questionnaire. Results Individuals with worried and autonomy-limiting caregivers reported higher levels of illness anxiety. Correlation analyses revealed significant positive associations with illness anxiety and all the variables measured. As expected, partial correlation demonstrated that separation/disloyalty guilt and burdening guilt are the most associated with illness anxiety symptoms. Unexpectedly, however, survivor guilt lost significance when controlling for other types of guilt. Hierarchical multiple regression identified anxiety as the strongest overall predictor of illness anxiety, followed by separation/disloyalty guilt and bodily reactivity indices. Discussion This study suggests that interpersonal guilt may be a key component in sustaining illness anxiety symptoms in anxious people. In particular, the interplay between anxiety, separation/disloyalty guilt, and autonomic overreactivity appears to contribute to illness anxiety concerns and behaviors. Working on these aspects may be essential for positive long-term outcomes of psychotherapy.

Childhood emotional abuse is a recognized factor for long-term psychological and physical health problems, including persistent somatic symptoms. Negative self-beliefs, such as self-hate-related beliefs, may explain how emotional mistreatment contributes to physical distress in adulthood beyond general emotional difficulties. A longitudinal study was conducted with 298 help-seeking adults. At baseline, participants completed measures of childhood emotional abuse, self-hate, and general negative affectivity. Somatic symptoms were assessed two months later. Mediation analyses tested whether self-hate mediated the relationship between childhood emotional abuse and somatic symptoms while accounting for the influence of general negative affectivity, which reflects a general tendency to experience negative emotional states. Participants (Mage = 33.7, SD = 11.8) were predominantly female (63.3%) and Caucasian (84.2%). Childhood emotional abuse (M = 11.24, SD = 6.60) was significantly associated with self-hate (M = 10.35, SD = 6.13, r = 0.33, p

Guilt and shame are emotions that, albeit subjectively negative, help humans adapt to their social environment. However, in some cases, there are pathogenic beliefs, shaped over the lifespan that sustain them and make them a source of psychopathological suffering. In this paper we will first briefly show how Control‐Mastery Theory (CMT) considers several types of pathogenic beliefs shaped by traumatic experiences that underly chronic feelings of guilt and shame. We then focus on a clinical case of Livia, a 28 year‐old woman with relational and academic problems suffering mainly from two such types of pathogenic beliefs: burdening guilt and disloyalty guilt. We describe how a) Livia was driven by adverse and traumatic experiences to form some of these pathogenic beliefs, b) how she tested the therapist in order to discover whether he would disconfirm these beliefs, and c) how the therapist was able to successfully pass these tests and provide her with new and healthier interpersonal experiences. The case of Livia will highlight therapists' ability to accurately formulate patients' goals, pathogenic beliefs—including types of guilt‐ and shame‐related beliefs—and traumas. Moreover, the case will illustrate how therapists can pass patients' tests and adopt the right attitude to help patients disprove their pathogenic beliefs and overcome problematic experiences of guilt and shame.

Pathological narcissism is a personality constellation comprising distorted self‐image, maladaptive self‐esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control‐mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time‐limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.

Pathological narcissism is a personality constellation comprising distorted self-image, maladaptive self-esteem regulation, and difficulties in intimate relationships. Patients with elevated pathological narcissism may not necessarily meet criteria for narcissistic personality disorder, and may seek treatment for a range of mental health concerns across various clinical settings. An understanding of key principles of control-mastery theory (CMT) can help clinicians understand the specific goals and challenges of the individual patient with pathological narcissism, and can illuminate ways in which the patient may work in psychotherapy. This paper outlines how patients with pathological narcissism may engage in testing of their pathogenic beliefs, and how therapists can respond in ways that facilitate the patient's sense of safety and foster psychological work. The role of the therapist's attitude is highlighted as a means for countering pathogenic beliefs associated with pathological narcissism. Clinical material from a single case of time-limited supportive psychotherapy will be used to illustrate these principles and associated therapeutic processes. Insights from CMT regarding pathogenic beliefs and the patient's plan for addressing them can help to explain how therapy works or does not work for patients with pathological narcissism.

The aim of this article is to show how the plan formulation method (PFM), an empirically validated method for case formulation based on control mastery theory (CMT), can help clinicians make sense of and use what they feel during sessions to better understand and treat their patients. We give a brief overview of the main psychoanalytic conceptions about countertransference, provide a brief introduction to CMT, and describe the concept of the plan and the PFM. We then show, using several brief clinical examples, how the components of the plan (patient’s goals, pathogenic beliefs, traumas, tests, and insights) may help understand clinicians’ in-session feelings.

The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

Psychotherapists can experience various kinds of emotions in response to their patients’ communications and behaviors over the course of therapy. These may be understood in the context of interpersonal dynamics associated with patients’ testing activity. The concept of testing, as part of the patient’s plan for therapy, is explained from the perspective of Control-Mastery Theory. Different kinds of testing behaviors, aimed at disconfirming the patient’s pathogenic beliefs, may evoke different emotions in the therapist. Understanding the patient’s testing strategies can help to make sense of the therapist’s emotional reactions, manage countertransference, and guide therapeutic responses. This paper describes testing behaviors, according to the patient’s compliance and non-compliance with pathogenic beliefs, along with corresponding therapist emotional responses. A descriptive clinical case is provided to illustrate various tests and their associated emotional reactions within a therapy session.

Termination processes in psychotherapy vary widely across patients, therapists, and therapies. While general guidelines on termination can inform ethical and responsible termination practices, termination decisions and processes are likely optimized using a case-specific approach. Control-mastery theory (CMT) provides a framework for considering the unique ways individual patients work in psychotherapy and can be applied to help therapists understand and facilitate optimal terminations. The present article provides a brief overview of CMT and outlines perspectives regarding the decision-making and discussion of psychotherapy termination, the processing of termination, and the final session of therapy. Question: How can psychotherapy termination be considered and responded to in a case-specific, personalized way? Findings: Control-mastery theory provides a framework for considering the patient’s adaptive goals, pathogenic beliefs, traumas, and tests in determining individualized clinical responses to termination-related issues in psychotherapy. Meaning: Clinicians can help patients disconfirm pathogenic beliefs—through passing their tests—throughout the termination process, including during the final psychotherapy session. Next Steps: Further research is needed to understand patients’ testing strategies specifically in the context of psychotherapy termination.

While several empirically supported models for treating personality disorder (PD) are available, researchers and clinicians have continued to advocate for the personalization of psychotherapy to the particular needs and characteristics of the individual patient with severe personality pathology. Control-Mastery Theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986) provides a useful framework for understanding personality pathology, and for guiding treatment with individualized case formulation. The present article introduces the basic concepts of CMT and their application in personalizing psychotherapy for patients with severe PDs. According to CMT, patients come to therapy in order to disprove the pathogenic beliefs that obstruct their pursue of healthy and adaptive developmental goals. These pathogenic beliefs were developed to adapt to early traumatic experiences, but end up causing further suffering, inhibitions, and symptoms. For this reason, patients test these pathogenic beliefs within the therapeutic relationship in search of corrective emotional experiences that disprove them. Among patients with severe PDs, such beliefs may be reciprocally contradictory and may be enacted in therapy in multiple different ways, often challenging therapists to respond appropriately. CMT suggests that therapists’ formulation regarding a given patient’s plan—including the nature of the patient’s goals, traumas, pathogenic beliefs, and testing strategies—allow for a personalized approach that will optimize therapy effectiveness.